Cervical Screening Guidelines Ignored

Action Points

Explain that many physicians recommend the HPV and Papanicolaou co-tests for cervical cancer screening on an annual basis, despite guidelines that call for re-screening every three years.

Note that the recommendations among physicians to extend the screening interval to three years were most likely to occur if a woman had a normal HPV test and a history of normal Pap results.

Many physicians recommend the HPV and Papanicolaou co-tests for cervical cancer screening on an annual basis, despite guidelines that call for re-screening every three years, researchers said.

National survey data show that about 51% of providers ordered the co-test, but in clinical vignettes, only about 14% recommended re-screening in three years for women with normal results, Katherine Roland, MPH, of the Centers for Disease Control and Prevention in Atlanta, and colleagues reported online in the American Journal of Obstetrics & Gynecology.

"Annual cervical cancer screening continues to be a common recommendation, regardless of whether a screening history has been established or an HPV test has been ordered," the researchers wrote.

Guidelines from the American Cancer Society in 2002 and the American College of Obstetricians and Gynecologists in 2003 recommend the co-test for women age 30 and up. If the results are normal on both tests, a three-year interval is recommended until the next screening.

To assess adoption of the guidelines, the researchers looked at 2006 data from two CDC surveys: the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, which included responses from 376 private office-based physicians and 216 physicians from hospital outpatient facilities.

Among office-based providers, 51% reported ordering the HPV co-test, as did a similar proportion of hospital based practices (51.4%). In both cases, the majority of tests were ordered appropriately, for women over age 30 (64.1% and 62.4%, respectively).

When doctors were given three clinical vignettes involving women ages 30 to 60, most of those who ordered the HPV test said they would order the next Pap test within a year:

For those with a current normal Pap test, no HPV test, and two consecutive normal Pap tests, 76.4% of office-based and 85.2% of hospital-based doctors said they'd recommend a new screen in 12 months.

For those with a normal Pap, a negative HPV, and two consecutive normal Pap results, 66.6% of office-based and 72.7% of hospital-based doctors recommended re-testing in a year. But the researchers noted that only 14% of office-based doctors would recommend the next test three years, as guidelines recommend, the researchers said.

For those with a normal Pap and a negative HPV test, but no documented Pap test results over the previous five years, 73.4% of office-based and 73.5% of hospital-based physicians recommended another screen in a year. In both cases, about about a quarter recommended re-testing before a full year passed.

Roland and colleagues noted that the recommendations among the physicians to extend the screening interval to three years were most likely to occur if a woman had a normal HPV test and a history of normal Pap results.

Re-testing within a year was most often recommended for those with normal HPV results but no documented history of a normal Pap test.

"Establishing a history of normal Papanicolaou test results with the patient appears to be a critical component to providers making guideline-supported screening interval recommendations," she and colleagues wrote.

They said the findings "suggest a need for continued surveillance and data collection on adherence to cervical screening guidelines, and perhaps an open dialogue on provider, patient, and systems preferences for prevention and management of cervical cancer and abnormalities."

The study was limited because a large percentage of the surveys were completed by "other office staff," who didn't identify as a physician or nurse, which may impact the accuracy of the findings, the researchers said.

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